11/33. Does avascular necrosis of the jaws in cancer patients only occur following treatment with bisphosphonates?INTRODUCTION: In the last decade, bisphosphonates were regularly used to treat osteoporosis and bone pain from diseases such as metastatic breast cancer, multiple myeloma and Paget's disease. Currently, the influence of bisphosphonates in development of avascular osteonecrosis of the jaws has been recognized by various authors. In many cancer patients chemotherapy and medications like steroids have also to be applied. Agreement exists that these drugs can initiate vascular endothelial cell damage and accelerate disturbances in the microcirculation of the jaws possibly resulting in thrombosis of nutrient end arteries. The role of bisphosphonates in cancer patients with previously treated jaws has yet to be elucidated. patients: Four case reports of 'cancer' patients are described in whom osteonecrosis of the jaws was found. In two patients, the nitrogen-containing bisphosphonate zoledronic acid was prescribed for additional therapy of malignancy for a period of 45 up to 70 months. In another case, supportive treatment of breast cancer was offered using ibandronate. The fourth patient suffered avascular necrosis of the mandible without ever having taken bisphosphonates. In any case, revisional, as well as extended surgery has to be performed for osteonecrosis because neither conservative debridement nor antibiotic therapy have shown long term success, with or without bisphosphonates. No withdrawal of bisphosphonates was performed in view of the information on the direct correlation of total dosage and duration of drug intake to systemic incorporation and the long time for drug release. CONCLUSION: According to our observations, withdrawal of bisphosphonates is not recommended when necrosis of the jaws has occurred.- - - - - - - - - - ranking = 1keywords = jaw, mandible (Clic here for more details about this article) |
12/33. osteonecrosis of the jaws and bisphosphonates. Report of three cases.Bisphosphonates are recently acquiring increasing relevance in the treatment of several diseases. In line with the increased use of these compounds, cases of mandibular osteonecrosis, and to a lesser extent, maxillary osteonecrosis, are being reported. This necrosis is difficult to treat in patients who usually have a previously limited quality of life. A surgical performance carried out by oral and maxillofacial surgeons, stomatologists and odontologists might lead to bone exposure. A treatment based on conservation and as harmless as possible seems to be the most advisable way of acting with these patients in order to minimize the incidence and treat the complications, once the lesions have been ascertained. We report three cases treated in our service of osteonecrosis of the jaws after exodontics. This side effect should be remembered before starting any surgical treatment in these patients.- - - - - - - - - - ranking = 0.52998177033952keywords = jaw (Clic here for more details about this article) |
13/33. association of osteonecrosis of the jaws and bisphosphonate pharmacotherapy: dental implications.Bisphosphonates are drugs of choice in the management of a variety of bone disorders including osteoporosis, Paget's disease and bone cancer. Recently there have been increasing reports of a possible relationship between bisphosphonate therapy and osteonecrosis of the jaws. osteonecrosis may occur following extractions or dental surgery and, in some cases, may appear spontaneously. Because of the potentially serious nature of these complications and the failure of exposed bone to heal, dentists must be aware of recommended precautions for the management of patients taking bisphosphonate medication.- - - - - - - - - - ranking = 0.52998177033952keywords = jaw (Clic here for more details about this article) |
14/33. Bisphosphonate-induced avascular osteonecrosis of the jaws: a clinical report of 11 cases.Bisphosphonates are compounds used in the treatment of various metabolic and malignant bone diseases. In the last 2 years there has been a significant increase in referrals to the Department of Oral and Maxillofacial Surgery of patients with exposed necrotic jaw bone, diagnosed elsewhere as chronic refractory osteomyelitis of jaws, mostly after several teeth extractions. The only clinical feature in common for all the patients was the use of bisphosphonates in the treatment of bone diseases. A retrospective study was performed of 11 patients with necrotic bone lesions of the jaws of various extents referred to this Department from July 2003 to November 2004. The management of the patients included cessation of bisphosphonate therapy for 2-8 months and various surgical restorative procedures thereafter. Four patients (36%) presented with maxillary bone involvement, 6 (55%) had mandibular bone necrosis and 1 (9%) presented with necrosis at 3 quadrants. All patients had received bisphosphonate therapy for 6 months to 5 years. Biopsies from the necrotic lesions revealed no metastatic disease. One patient who was removed from bisphosphonate therapy for 8 months recovered completely, one other who was not removed from bisphosphonate therapy relapsed and for all the others, with cessation of bisphosphonate therapy for 2-6 months, the results were inconsistent. A new complication of bisphosphonate therapy administration, i.e. osteonecrosis of jaws, seems to be developing. The improved results after cessation of the medication should make clinicians reconsider the merits of the rampant use of bisphosphonates, while further investigation is needed to completely elucidate this complication.- - - - - - - - - - ranking = 0.84797083254323keywords = jaw (Clic here for more details about this article) |
15/33. jaw osteonecrosis associated with use of bisphosphonates and chemotherapy: paradoxical complication of treatment of bone lesions in multiple myeloma patients.It has been demonstrated that bisphosphonate-based supportive therapy (pamidronate or zoledronate) reduces skeletal events (onset or progression of osteolytic lesions) both in patients with multiple myeloma (MM) and in cancer patients with bone metastasis. Bisphosphonates (eg, alendronate) are also indicated in the treatment of osteoporosis. Nevertheless, osteonecrosis of the jaw (ONJ) has been reported in some patients being treated with bisphosphonates. We present a series of 9 MM patients who developed ONJ after treatment with bisphosphonates and chemotherapy. All the patients in this case series had undergone tooth extraction for recurrent dental abscesses while taking bisphosphonates. We also review the diagnostic and therapeutic implications of this paradoxical complication associated with treatment of bone lesions in MM.- - - - - - - - - - ranking = 0.1059963540679keywords = jaw (Clic here for more details about this article) |
16/33. Palifermin in a hematopoietic stem cell transplant patient with osteonecrosis of the jaw.This case report describes the use of palifermin in a multiple myeloma patient with a history of osteonecrosis of the jaw (ONJ) for the prevention of high-dose chemotherapy-induced mucositis. Following the day of autologous stem cell infusion, palifermin was discontinued secondary to adverse events. Specifically, palifermin-associated macroglossia seemed to exacerbate the pain localized in the oral cavity area affected by ONJ, necessitating escalated doses of narcotic analgesics. When contemplating palifermin as a mucosal protectant in a hematopoietic stem cell transplant patient with ONJ, a careful benefit-to-risk assessment is in order to ensure optimal effectiveness without undue harm.- - - - - - - - - - ranking = 0.52998177033952keywords = jaw (Clic here for more details about this article) |
17/33. Plasma-cell tumours of the condyle.Plasma cell tumours are a group of disorders which are characterized by neoplastic proliferation of atypical plasma cells involved in the production of monoclonal immunoglobulins. Bone pain, renal insufficiency and normocytic-normochromic anaemia are suggestive data for diagnosis. In 12-15% of cases of multiple myeloma, the first manifestation of the disease appears in the jaw bones and oral cavity. Two cases of multiple myeloma affecting the mandibular condyle are presented, and the incidence of oral and maxillofacial lesions is briefly reviewed.- - - - - - - - - - ranking = 0.1059963540679keywords = jaw (Clic here for more details about this article) |
18/33. A large mandibular tumor with a distinct radiological "sun-ray effect" as the primary manifestation of multiple myeloma.The significant feature of the reported case was that of a sinister-looking mandibular tumor highly suggestive of a metastatic lesion or of osteogenic sarcoma. A biopsy specimen and results of a thorough medical work-up showed the lesion to be multiple myeloma. The myeloma cells apparently have the capability to stimulate osteoblastic activity and new bone formation. This capability should be kept in mind when making the differential diagnosis of osteoblastic bony lesions of the jaws.- - - - - - - - - - ranking = 0.1059963540679keywords = jaw (Clic here for more details about this article) |
19/33. Mandibular lesion as the first evidence of multiple myeloma. Case report.Plasma cell dyscrasias affect the jaws relatively infrequently, and on rare occasions this is the first sign of the disease. This article describes the case of a patient aged 53 who presented with a lytic lesion in the right mandible which was initially diagnosed as an ameloblastoma. The diagnosis was made histopathologically and further investigation showed that the patient had multiple myelomatosis.- - - - - - - - - - ranking = 0.15202916745677keywords = jaw, mandible (Clic here for more details about this article) |
20/33. An unusual case of Bence Jones myeloma with extremely low levels of monoclonal immunoglobulin.This report describes the case of a 64-year-old woman with painful symptoms of the mandible produced by a lesion diagnosed as Bence Jones myeloma (kappa type). A bone survey revealed osteolytic lesions in the mandible, cranial bones, and humerus. urinalysis showed no abnormality regarding the presence of monoclonal immunoglobulin fragments. serum analysis by electrophoresis and immunoelectrophoresis did not demonstrate the presence of monoclonal immunoglobulin. However, the latter procedure disclosed a precipitation line formed by concentrated urine against anti-kappa serum. Microscopic examination of a mandibular specimen revealed numerous atypical plasma cells. Immunoperoxidase studies demonstrated kappa-chains localized within the rough endoplasmic reticulum, perinuclear region, and golgi apparatus of the myeloma cells. The pathogenetic mechanism of the condition in this case, as well as its relation to Bence Jones myeloma and nonsecretory myeloma, is discussed.- - - - - - - - - - ranking = 0.092065626777738keywords = mandible (Clic here for more details about this article) |
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